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NPI Code Detail

MEDICARE: MARJORIE BERGISTE

MEDICARE: MARJORIE BERGISTE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist30063FL

General Provider Information

NPI Number : 1235522590
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARJORIE BERGISTE
Provider Business Mailing Address
First Line : 10352 OLD WINSTON CT
Second Line :
City : LAKE WORTH
State : FL
Zip : 33449-5474
Country : US
Telephone Number : 407-247-6114
Fax Number :
Provider Business Practice Location Address
First Line : 5100 CRESTHAVEN BLVD
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33415-8618
Country : US
Telephone Number : 561-964-2828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2015
Last Update Date : 03/11/2015

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Directions to “ MARJORIE BERGISTE ” Practice Location

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